Supplemental Payments

0745.030.05 PRE-CLOSING EX-PARTE REVIEW

IM-#193 December 28, 2000

If a change in circumstances results in a determination of ineligibility for SP-Only and SSI-SP, ineligibility for all Medicaid/MC+ categories must be established prior to taking action to close the case. All available information must be carefully reviewed. If potential eligibility exists under another category, change the case address if necessary, and continue Medicaid under the conversion case number (type of assistance A,E, or F) as a level of care T while exploring the other eligibility. Action may be taken to discontinue the cash grant while not affecting the Medicaid eligibility.

Do not ask the claimant to provide new information that is available to the agency or to re-verify current case information. In some situations it may be necessary to obtain additional information from the client to determine eligibility in another category. Do not close while attempting to complete the new eligibility determination.

If the claimant is determined eligible under another category, switch the individual to the appropriate category (an IM-1 is not necessary). Process both closing and approval transactions on the same day in order to prevent any disruption in healthcare coverage.

If the category the claimant is eligible is MA-spend down send an advance notice of adverse action (IM-80) notifying the claimant they will become spend down the month after the IM-80 expires. After the IM-80 expires, register an MA-spend down application and:

  1. Close the conversion case Medicaid at the end of the current month.
  2. Approve the MA-spend down case with a Title XIX begin date of the first date of the next month.
  3. Send the claimant a Notification of Approval for Medicaid spend down (IM-32SPND). If no other eligibility exists, initiate action to close the case by sending an advance notice of adverse action (IM-80). If a hearing is not requested close the active SNC case once the IM-80 expires and notify the claimant in writing (IM-33) confirming the closing.